马肠秘结病因和机制的分析

肠秘结的病原是秘结团堵塞肠道。肠道形成超正常大的粪团,或粪糜堆积,肠运动和分泌机能的衰竭,引起心肌的衰竭、有毒物质的吸收,……。以此论肠秘结的病因是胃肠机能紊乱的因素造成的,如饲料质量不佳,饮喂不规律、劳逸不均、以及气候突变等。

牛肠秘结的治疗措施

牛肠秘结是一种常见牛病,多发于一些成年牛或老弱的牛,患牛会因该病的发生而食欲不振、日渐消瘦,影响养殖户的经济效益,因此要深入分析其发生原因,并进行相应的治疗。

中西医结合治疗马肠燥秘结

肠燥秘结是马属动物的一种常见疾病。笔者自1978年以来,采用中西医结合的方法诊治35例,,治愈34例,死亡1例,现介绍如下: 临床症状:初期体温升高40—42.5℃,精神沉郁,头低耳耷,食欲减退或废绝。可视粘膜发绀,呼吸次数增加,肺泡音粗厉,诱咳阳性。肠蠕动音减弱,排粪次数减少,小便短赤。病情进一步发展。

应用果导治疗羊肠便秘55例

羊由于食进的草料经过反刍并在前胃中充分混合、浸软、分解发酵,所以肠便秘较少发生,但若发病,则治疗比较困难。我场的纯种羊曾因肠便秘而受到一定损失。据文献报道,在绵羊网胃直接注射药物。

顽固性猪便秘的诊治

近年来,我区养猪业发生性顽固性便秘十分普遍,发生便秘轻者会造成猪食欲不振、营养摄入不足、母猪产后无乳、产弱仔等现象,重者会造成消化吸收机能紊乱、精神异常,严重的会造成死亡。1.发病原因肠变秘,是某些传染病。

Colonic exclusion and combined therapy for refractory constipation

AIM: To investigate the therapeutic effectiveness of colonic exclusion and combined therapy for refractory constipation. METHODS: Thirty-two patients with refractory constipation were randomly divided into treatment group (n = 14) and control group (n = 18). Fourteen patients in treatment group underwent colonic exclusion and end-to-side colorectal anastomosis. Eighteen patients in control group received subtotal colectomy and end-to- end colorectal anastomosis. The therapeutic effects of the operations were assessed by comparing the surgical time, incision length, volume of blood losses, hospital stay, recovery rate and complication incidence. All patients received long-term follow-up. RESULTS: All operations were successful and patients recovered fully after the operations. In comparison of treatment group and control group, the surgical time (h), incision length (cm), volume of blood losses (mL), hospital stay (d) were 87 ± 16 min vs 194 ± 23 min (t = 9.85), 10.4 ± 0.5 cm vs 21.2 ± 1.8 cm (t = 14.26), 79.5 ± 31.3 mL vs 286.3 ± 49.2 mL (t = 17.24), and 11.8 ± 2.4 d vs 18.6 ± 2.6 d (t = 6.91), respectively (P < 0.001 for all). The recovery rate and complication incidence were 85.7% vs 88.9% (P = 0.14 > 0.05), 21.4% vs 33.3% (P = 0.73 > 0.05), respectively. CONCLUSION: Colonic exclusion has better therapeutic efficacy on refractory constipation. It has many advantages such as shorter surgical time, smaller incision, fewer blood losses and shorter hospital stay.

Favorable surgical treatment outcomes for chronic constipation with features of colonic pseudo-obstruction

AIM:To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.METHODS:Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected.We identified a subgroup with colonic pseudo-obstruction(CPO) features,with dilatation of the colon proximal to the narrowed transitional zone,in contrast to typical slowtransit constipation(STC),without any dilated colonic segments.The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.RESULTS:Of the 42 patients who underwent surgery for constipation,33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone.There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years.All had symptoms of chronic intestinal obstruction,including abdominal distension,pain,nausea,or vomiting,and the mean duration of symptoms was 67 mo(range:6-252 mo).Preoperative defecation frequency was 1.5 ± 0.6 times/wk(range:1-2 times/wk).Thirty-two patients underwent total colectomy,and one patient underwent diverting transverse colostomy.There was no surgery-related mortality.Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients.In contrast,histology of STC group revealed intestinal neuronal dysplasia type B(n = 6) and visceral myopathy(n = 3).Early postoperative complications developed in six patients with CPO;wound infection(n = 3),paralytic ileus(n = 2),and intraabdominal abscess(n = 1).Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d(range:1-15 times/d).Long-term follow-up(median:39.7 mo) was available in 32 patients;all patients had improvements in constipation symptoms,but two patients needed intermittent medication for management of diarrhea.All 32 patients had distinct improvements in constipation symptoms(with a mean bowel frequency of 3.3 ± 1.3 times/d),social activities,and body mass index(20.5 kg/m 2 to 22.1 kg/m 2) and were satisfied with the results of their surgical treatment.In comparison with nine patients who underwent colectomy for STC without colon dilatation,those in the CPO group had a lower incidence of small bowel obstructions(0% vs 55.6%,P < 0.01) and less difficulty with long-distance travel(6.7% vs 66.7%,P = 0.007) on long-term follow-up.CONCLUSION:Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.

Colectomy for idiopathic slow transit constipation

Objective: To evaluate the intervention of colectomy on a group of patients with idiopathic slow transit constipation (STC). Methods: Thirty-four patients with STC, underwent colectomy during recent 10 years in our department , were subjected and followed for a mean length of 34 months, and their colon transits, defecograms, colonoscopic examination, sex hormone detection, and immunohistochemical studies were retrospectively reviewed. Results: The co-Ionic transit time ranged from 96 to 240 h, with a mean time of 136 h. Eighty-five percent of patients (29/34) accompanied with outlet obstructed constipation, and 50% ( 17/34) showed abnormal sex hormone levels. Colectomy obtained satisfactory results in most patients, except one case of recurrence. Moreover, more neurons positive to nitric oxide synthase (NOS) and lesser to vasoactive intestinal polypeptide (VIP) were seen in the colonic myenteric plexus. Conclusion: Colectomy produces a satisfactory functional outcome in the majority of patients undergoing surgery for slow transit constipation, but accompanied pelvic dysfunction must be corrected simultaneously.

Colonic duplication in an adult who presented with chronic constipation attributed to hypothyroidism

Gastrointestinal duplications are an uncommon congenital abnormality that manifest before the age of two in 80% of cases. Ileal duplication is the most common while colonic duplication, either cystic or tubular, occurs in 10%-15% of cases and remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults in only a few cases. The most common clinical manifestations are abdominal pain and intestinal obstruction. Rarely, duplications present with signs of acute abdomen or acute bleeding. This study reports a case of colonic duplication in an adult who presented with chronic constipation. Complete diagnostic workup was made on several occasions during the previous eight year period, but no pathology was found and chronic constipation was attributed to hypothyroidism caused by long standing Hashimoto thyroiditis. Nultislice CT, performed because of abdominal distension, defined colonic pathology but the definite diagnosis of duplication of the transversal colon was made at operation. The cystic duplication and the adjacent part of the ascending and transversal colon were excised enblock. This study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of chronic constipation even when precipitating factors for constipation, such as hypothyroidism are present.

Anal plugs and retrograde colonic irrigation are helpful in fecal incontinence or constipation

AIM： To evaluate the feasibility, clinical effect and predicting factors for favorable outcome of treatment with anal plugs in fecal incontinence and retrograde colonic irrigation （RCI） in patients with fecal incontinence or constipation.METHODS： Patients who received treatment with an anal plug or RCI between 1980 and 2005 were investigated with a questionnaire.RESULTS： Of the 201 patients （93 adults, 108 children）, 101 （50%） responded. Adults： anal plugs （8）, five stopped immediately, one stopped after 20 mo and two used it for 12-15 too. RCl （40, 28 fecal incontinence, 12 constipation）, 63% are still using it （mean 8.5 years）, 88% was satisfied. Younger adults （〈 40 years） were more satisfied with RCI （94 % vs 65%, P = 0.05）. Children： anal plugs （7）, 5 used it on demand for an average of 2.5 years with satisfactory results, one stopped immediately and one after 5 years. RCI （26 fecal incontinence, 22 constipation）, 90% are still using it （mean time 6.8 years） and felt satisfied. Children tend to be more satisfied （P = 0.001）. Besides age, no predictive factors for success were found. There was no difference in the outcome between patients with fecal incontinence or constipation.CONCLUSION： RCI is more often applied than anal plugs and is helpful in patients with fecal incontinence or constipation, especially for younger patients. Anal plugs can be used incidentally for fecal incontinence, especially in children.

Lubiprostone:Clinical applications beyond constipation

In comparison to polyethylene glycol,lubiprostone offers other advantages and is increasingly being used as an adjunctive agent in diagnostic as well as management strategies not only in gastroenterology, but in other fields.For instance,lubiprostone exerts beneficial effects in cystic fibrosis tissues.It augmernts the chloride secretion in these cells by activating non-cystic fibrosis transmembrane regulator(CFTR) secretion of chloride by afflicted respiratory epithelia. Lubiprostone also seems to improve visualization of the gastrointestinal tract during procedures such as colonoscopy.This is especially true if the lubiprostone is administered prior to bowel cleansing with agents such as polyethylene glycol electrolyte(PEG-E). Lubiprostone also enhances and stimulates contraction in colonic as well as gastric muscles and may thus further contribute as a prokinetic agent.Besides these effects,lubiprostone also causes hyperpolarization in other tissues such as uterine muscle cells.This may prove to be of significant clinical benefit in the management of uterine pathologies in the near future.

Outcomes and prognostic factors of fecal microbiota transplantation in patients with slow transit constipation:results from a prospective study with long-term follow-up

Background and aim:Gutmicrobiotamay contribute to regulate colonicmotility,which is involved in the etiology of constipation.Fecalmicrobiota transplantation(FMT)has been demonstrated to restore intestinal homeostasis.The aimof this study was to evaluate the clinical outcomes and prognostic factors of FMT for the treatment of slow transit constipation(STC).Methods:Fifty-two patients with STC received standardized FMT and were followed up for 6 months.Bowel habit,colonic transit time,constipation-related symptoms(PAC-SYM score),quality of life(PAC-QOL score),treatment satisfaction scores and adverse events were monitored.The primary efficacy endpoint was the proportion of patients having on average three or more complete spontaneous bowel movements(CSBMs)per week.Results:The primary efficacy endpoint was achieved in 50.0%,38.5%and 32.7%of patients over week intervals 3–4,9–12 and 21–24,respectively(P<0.01 for all comparisons).Significant improvements were also observed in other bowel movement assessments,colonic transit time,constipation-related symptoms and quality of life;but all improvements diminished at weeks 12 and 24.Incompleteness of evacuation served as the only factor associated with efficacy.No serious treatmentrelated adverse events were observed.Conclusion:This study suggested FMT was effective and safe for STC,while a late loss of efficacy was also observed.A lower degree of sensation of incompleteness predicted a better outcome.

Clinical Study on Deep Insertion at Tianshu (ST 25) for Colonic Slow Transit Constipation

Objective：To observe the clinical effect of deep insertion at Tianshu（ST 25）for colonic slow transit constipation（STC）.Methods：120 cases of STC patients were randomly divided,60 cases in a deep insertion group,30 cases in an electroacupuncture group and 30 cases in a medication group by 2：1：1 ratio.The deep insertion group was treated with deep insertion at Tianshu（ST 25）.The electroacupuncture group was treated with routine insertion at Tianshu（ST 25）.The medication group was treated with oral administration of Lactulose oral liquid.The first voluntary defecation time,and constipation scores before the treatment,four weeks after the treatment and relevant scores of clinical symptoms were assessed in the three groups of the patients.Results：The scores of the clinical symptoms in improvement of constipation were better in the deep insertion group than in the electroacupuncture group and medication group,with differences in statistical significance（P〈0.01）.The unsuccessful numbers in the improvement of defecation and abdominal pain were also better in the deep insertion group than in the other two groups,and better in instant effect in the deep insertion.Conclusion：The improvement of STC clinical symptoms was better by deep insertion at Tianshu（ST 25）than by medication and routine acupuncture method at Tianshu（ST 25）.